Kenneth Richard Phelps, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9107403 Issued in FL

Practice address

3599 University Blvd S
BLDG. 300
Jacksonville, FL 32216-4252

Phone

(904) 399-5550

Fax

(904) 346-4334

NPI assigned

Sep 13, 2013

Last updated

Feb 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

At Still University, Arizona School of Dentistry & Oral HLTH, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Radiology Services P CGroup PAC ID 3577454024, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Henry Hospital Hospital, Stockbridge, GA, CCN 110191
• Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Radiology Services P C

  • Diagnostic Radiology Physician
  • Cartersville, GA
  • NPI 1174572374
  Medicare reassignment Care Compare group
• Mori Bean and Brooks Inc

  dba Coastal Vein Vascular Institute

  • Diagnostic Radiology Physician
  • Tampa, FL
  • NPI 1093782070

  Physician Assistant

  NPD (past)
• Georgia Radiology Imaging Consultants, LLC

  • Diagnostic Radiology Physician
  • Harvey, IL
  • NPI 1831461771
  NPD (past)
• Radiology Associates of Dekalb PC

  • Diagnostic Radiology Physician
  • Decatur, GA
  • NPI 1245206119
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  dba Northside Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation
• Piedmont Henry Hospital, Inc.

  • General Acute Care Hospital
  • Stockbridge, GA
  • NPI 1225034333
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1669807210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200096",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301209002",
            "telephone_number": "678-905-7053",
            "fax_number": "678-905-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "BLDG. 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-399-5550",
            "fax_number": "904-346-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "KENNETH",
        "middle_name": "RICHARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-13",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Phelps
• Benjamin Matthew Phelps, MD
• Diana Marie Phelps, MD
• Jordan Micah Phelps, DO
• Julie Phelps
• Laran Phelps, LMT
• Shericka Rose Phelps
• Phenomenal Healthcare, LLC (Home Care for the 21st Century- Jacksonville)
• Dalia Philbeck, ARNP, CNM
• Lauren Beth Philbrick

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.